Measurement of breast artery calcification using an artificial intelligence detection model and its association with major adverse cardiovascular events

Breast artery calcification (BAC) obtained from standard mammographic images is currently under evaluation to stratify risk of major adverse cardiovascular events in women. Measuring BAC using artificial intelligence (AI) technology, we aimed to determine the relationship between BAC and coronary artery calcification (CAC) severity with Major Adverse Cardiac Events (MACE). This retrospective study included women who underwent chest computed tomography (CT) within one year of mammography. T-test assessed the associations between MACE and variables of interest (BAC versus MACE, CAC versus MACE). Risk differences were calculated to capture the difference in observed risk and reference groups. Chi-square tests and/or Fisher's exact tests were performed to assess age and ASCVD risk with MACE and to assess BAC and CAC association with atherosclerotic cardiovascular disease (ASCVD) risk as a secondary outcome. A logistic regression model was conducted to measure the odds ratio between explanatory variables (BAC and CAC) and the outcome variables (MACE). Out of the 99 patients included in the analysis, 49 patients (49.49%) were BAC positive, with 37 patients (37.37%) CAC positive, and 26 patients (26.26%) had MACE. One unit increase in BAC score resulted in a 6% increased odds of having a moderate to high ASCVD risk >7.5% (p = 0.01) and 2% increased odds of having MACE (p = 0.005). The odds of having a moderate-high ASCVD risk score in BAC positive patients was higher (OR = 4.27, 95% CI 1.58-11.56) than CAC positive (OR = 4.05, 95% CI 1.36-12.06) patients. In this study population, the presence of BAC is associated with MACE and useful in corroborating ASCVD risk. Our results provide evidence to support the potential utilization of AI generated BAC measurements from standard of care mammograms in addition to the widely adopted ASCVD and CAC scores, to identify and risk-stratify women who are at increased risk of CVD and may benefit from targeted prevention measures.